Georg Röggla: Evidence and quality in intensive care medicine

Georg Röggla‘The H1N1 pandemic-are we prepared?’ was the first hot topic at the 22nd congress of the European society of intensive care medicine (ESICM) in Vienna from 11th to 14th October 2009. The question of whether there will there be enough intensive care facilities for critically ill patients in a second wave of the pandemic was discussed extensively. Steve Webb from Canberra, Australia reported that, in the influenza A/H1N1 pandemic that affected Australia and New Zealand during the 2009 southern hemisphere winter, 133 patients with influenza had to have mechanical ventilation and 68 patients with severe influenza-associated acute respiratory distress syndrome (ARDS) were treated with extracorporeal membrane oxygenation ECMO.

The president of ESICM, Rui Paulo Moreno from Lisbon, Portugal, said that a similar pandemic in his country would overburden the medical system in his country considerably. If only 10 % of the ten million Portuguese inhabitants were infected with A/H1N1 he reckons there would be 10,000 admissions to hospital and the need for about 2000 ICU beds within a very short time. There are about 300 ICU beds in the whole of Portugal and only one ECMO facility. Jean-Daniel Chiche from Paris, France agreed and told the audience that, while only a small proportion of A/H1N1 infected patients will require ICU admission, this could all the same result in a much greater demand for critical care at the peak surge of the pandemic than could be offered throughout Europe. Wolfgang Graninger from Vienna, Austria, however, thought that up to now the situation in Europe did not look quite so dramatic with about 45,000 reported cases of A/H1N1 infections and a mortality of about 0.1 %.

Together with representatives of about 60 critical care societies from around the world ESICM has launched a major initiative on patient safety in intensive care: ‘Patient safety in the ICU: The Vienna Declaration’. Presented at the conference, the declaration’s key elements include the recognition that the safety of patients and healthcare teams is a major challenge in modern day medicine and that, without a safe environment it is impossible to provide high quality care, especially in intensive care medicine. ESICM president elect Andrew Rhodes from London, UK, set this in its political context: ‘Over 10 years the political focus has been on performance targets. But, for the patient, what’s more important is its quality. Patient safety and quality are interlinked. Funding has shifted in Europe with the necessity to push as many patients as possible through the same number of beds. This has a direct impact on safety and quality, so we have to step back and see what’s right for the patient, not the politician and the funders or economists’.

The theme of evidence based medicine ran through the conference, and a lot of effort was put in to giving the around 5000 participants insights into its principles. Michael Hiesmayr from Vienna, Austria warned that one could not take it for granted that every ICU physician knew how to read and interpret studies. He convinced the audience that this was easily learnable and that EBM is a help, not a hindrance.

Georg Röggla is an associate editor with the BMJ.